Subject(s)
Antibodies, Monoclonal, Humanized/adverse effects , Encephalitis/chemically induced , Hashimoto Disease/chemically induced , Thalamus/diagnostic imaging , Aged , Antibodies, Monoclonal, Humanized/therapeutic use , Carcinoma, Non-Small-Cell Lung/drug therapy , Encephalitis/diagnostic imaging , Encephalitis/drug therapy , Female , Glucocorticoids/therapeutic use , Hashimoto Disease/diagnostic imaging , Hashimoto Disease/drug therapy , Humans , Immunoglobulins, Intravenous/therapeutic use , Lung Neoplasms/drug therapy , Magnetic Resonance Imaging , Treatment OutcomeABSTRACT
The new severe acute respiratory syndrome- coronavirus 2 is reported to affect the nervous system. Among the reports of the various neurological manifestations, there are a few documented specific processes to explain the neurological signs. We report a para-infectious encephalitis patient with clinical, laboratory, and imaging findings during evolution and convalescence phase of coronavirus infection. This comprehensive overview can illuminate the natural history of similar cases. As the two previously reported cases of encephalitis associated with this virus were not widely discussed regarding the treatment, we share our successful approach and add some recommendations about this new and scarce entity.
Subject(s)
Consciousness Disorders/physiopathology , Coronavirus Infections/physiopathology , Encephalitis/physiopathology , Glucocorticoids/therapeutic use , Immunoglobulins, Intravenous/therapeutic use , Immunologic Factors/therapeutic use , Methylprednisolone/therapeutic use , Pneumonia, Viral/physiopathology , Seizures/physiopathology , Adult , Anti-Bacterial Agents/therapeutic use , Anticonvulsants/therapeutic use , Atazanavir Sulfate/therapeutic use , Betacoronavirus , Brain/diagnostic imaging , COVID-19 , Consciousness Disorders/diagnostic imaging , Consciousness Disorders/etiology , Consciousness Disorders/therapy , Coronavirus Infections/complications , Coronavirus Infections/diagnostic imaging , Coronavirus Infections/therapy , Diffusion Magnetic Resonance Imaging , Disease Progression , Encephalitis/diagnostic imaging , Encephalitis/etiology , Encephalitis/therapy , Female , HIV Protease Inhibitors/therapeutic use , Humans , Hydroxychloroquine/therapeutic use , Intensive Care Units , Levetiracetam/therapeutic use , Lung/diagnostic imaging , Magnetic Resonance Imaging , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/therapy , Pons/diagnostic imaging , Respiration, Artificial , SARS-CoV-2 , Seizures/drug therapy , Seizures/etiology , Temporal Lobe/diagnostic imaging , Thalamus/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
Purpose To investigate the association of inflammation and brain edema in a cerebral malaria (CM) mouse model with a combination of bis-5-hydroxy-tryptamide-diethylenetriaminepentaacetate gadolinium, referred to as MPO-Gd, and cross-linked iron oxide nanoparticle (CLIO-NP) imaging. Materials and Methods Female wild-type (n = 23) and myeloperoxidase (MPO) knock-out (n = 5) mice were infected with the Plasmodium berghei ANKA strain from May 2016 to July 2018. Seven healthy mice served as control animals. At a Rapid Murine Coma and Behavioral Scale (RMCBS) score of less than 15, mice underwent MRI at 9.4 T and received gadodiamide, MPO-Gd, or CLIO-NPs. T1-weighted MRI was used to assess MPO activity, and T2*-weighted MRI was used to track CLIO-NPs. Immunofluorescent staining and flow cytometric analyses characterized CLIO-NPs, MPO, endothelial cells, and leukocytes. An unpaired, two-tailed Student t test was used to compare groups; Spearman correlation analysis was used to determine the relationship of imaging parameters to clinical severity. Results MPO-Gd enhancement occurred in inflammatory CM hotspots (olfactory bulb > rostral migratory stream > brainstem > cortex, P < .05 for all regions compared with control mice; mean olfactory bulb signal intensity ratio: 1.40 ± 0.07 vs 0.96 ± 0.01, P < .01). The enhancement was reduced in MPO knockout mice (mean signal intensity ratio at 60 minutes: 1.13 ± 0.04 vs 1.40 ± 0.07 in CM, P < .05). Blood-brain barrier compromise was suggested by parenchymal gadolinium enhancement, leukocyte recruitment, and endothelial activation. CLIO-NPs accumulated mainly intravascularly and at the vascular endothelium. CLIO-NPs were also found in the choroid plexus, indicating inflammation of the ventricular system. Blood-cerebrospinal fluid barrier breakdown showed correlation with brain swelling (r2: 0.55, P < .01) and RMCBS score (r2: 0.75, P < .001). Conclusion Iron oxide nanoparticle imaging showed strong inflammatory involvement of the microvasculature in a murine model of cerebral malaria. Furthermore, bis-5-hydroxy-tryptamide-diethylenetriaminepentaacetate gadolinium imaging depicted parenchymal and intraventricular inflammation. This combined molecular imaging approach links vascular inflammation to breakdown of the blood-brain barrier and blood-cerebrospinal fluid barrier that correlate with global brain edema and disease severity. © RSNA, 2018 Online supplemental material is available for this article. See also the editorial by Kiessling in this issue.
Subject(s)
Brain Edema , Encephalitis , Magnetic Resonance Imaging/methods , Magnetite Nanoparticles/chemistry , Malaria, Cerebral , Peroxidase/metabolism , Animals , Brain/diagnostic imaging , Brain/enzymology , Brain/pathology , Brain Edema/diagnostic imaging , Brain Edema/enzymology , Brain Edema/parasitology , Brain Edema/pathology , Disease Models, Animal , Encephalitis/diagnostic imaging , Encephalitis/enzymology , Encephalitis/parasitology , Encephalitis/pathology , Female , Malaria, Cerebral/complications , Malaria, Cerebral/diagnostic imaging , Malaria, Cerebral/enzymology , Malaria, Cerebral/pathology , Mice , Mice, Inbred C57BL , Mice, KnockoutSubject(s)
Dengue/complications , Encephalitis/complications , Antibodies/metabolism , Dengue/diagnostic imaging , Encephalitis/diagnostic imaging , Female , Gravidity , Humans , Magnetic Resonance Imaging , Thalamus/diagnostic imaging , Thalamus/virology , Viral Nonstructural Proteins/immunology , Young AdultABSTRACT
PURPOSE: Mycoplasma pneumoniae, a common respiratory pathogen, has been implicated as an etiology of encephalitis, but there are few reports about it and postencephalitic epilepsy. This study aimed to investigate clinical factors, electroencephalography, and neuroradiologic features of M. pneumoniae-related encephalitis in a series of children with postencephalitic epilepsy and to examine possible prognostic factors. METHODS: Cases of M. pneumoniae-related encephalitis between January 2001 and June 2010 were retrospectively reviewed. Systematic clinical data were evaluated. KEY FINDINGS: The 99 enrolled patients with M. pneumoniae-related encephalitis were all positive by serology and 47 (47.5%) of them developed postencephalitic epilepsy. During the acute phase, 53 patients (53.5%) had seizures, the most common type of which was primary focal with secondary generalized tonic-clonic seizure (39.6%). The most common initial electroencephalography was focal/diffuse cortical dysfunction (37.4%) and focal epileptiform discharge (26.4%). The time of follow-up ranged from 6-131 months. At the end of the study, 19 (40.4%) of the 47 children with postencephalitic epilepsy had intractable seizures. SIGNIFICANCE: Postencephalitic epilepsy is not a rare complication of M. pneumoniae-related encephalitis. Seizures in the acute phase and focal epileptiform discharges in initial electroencephalography are significant prognostic factors.
Subject(s)
Encephalitis/complications , Epilepsy/etiology , Mycoplasma pneumoniae , Pneumonia, Mycoplasma/complications , Adolescent , Brain/diagnostic imaging , Brain/physiopathology , Child , Child, Preschool , Drugs, Chinese Herbal , Electroencephalography , Eleutherococcus , Encephalitis/diagnosis , Encephalitis/diagnostic imaging , Encephalitis/microbiology , Encephalitis/physiopathology , Epilepsy/diagnosis , Epilepsy/diagnostic imaging , Epilepsy/microbiology , Epilepsy/physiopathology , Female , Humans , Infant , Magnetic Resonance Imaging , Male , Prognosis , Retrospective Studies , Risk Factors , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: Thyrotropin-releasing hormone (TRH) is now used as a therapeutic agent for various neurological disorders. Animal study has shown that TRH was attributable to increased cerebral blood flow (CBF). AIMS: There have been occasional reports that TRH therapy was effective for improving symptoms of persistent disturbance of consciousness after acute encephalitis or encephalopathy during childhood. To determine whether TRH has an effect on increasing CBF to patients who have consciousness disturbance caused by acute encephalitis or encephalopathy, and to determine the optimal method of administration. METHODS: Sixteen patients aged 0.7-10.9 years (mean age, 3.2+/-3.1 years) who presented with persistent disturbance of consciousness resulting from acute encephalitis or encephalopathy and were treated with TRH. Regional CBF (rCBF) was measured by single photon emission computed tomography before and after TRH therapy. The alteration rates of rCBF were compared between the divided two groups concerning the dose levels, dosing periods, and treatment lags. RESULTS: The alteration rates of rCBF of the high dose group were higher than those of the low dose group. Differences in the dosing periods and treatment lags did not cause any significant difference of the alteration rates of rCBF. CONCLUSION: The study showed that higher alteration rates of the CBF were observed in the higher dosing group, and TRH have the potency of increasing CBF. TRH therapy would have the potential for effective treatment of persistent consciousness disturbance caused by childhood acute encephalitis or encephalopathy.
Subject(s)
Brain Damage, Chronic/drug therapy , Brain Damage, Chronic/physiopathology , Cerebrovascular Circulation/drug effects , Encephalitis/drug therapy , Encephalitis/physiopathology , Thyrotropin-Releasing Hormone/therapeutic use , Autoradiography , Brain/diagnostic imaging , Brain Damage, Chronic/diagnostic imaging , Child , Child, Preschool , Consciousness Disorders/diagnostic imaging , Consciousness Disorders/drug therapy , Consciousness Disorders/physiopathology , Diagnostic Imaging , Dose-Response Relationship, Drug , Encephalitis/diagnostic imaging , Female , Humans , Infant , Iofetamine , Male , Radiopharmaceuticals , Thyrotropin-Releasing Hormone/administration & dosage , Thyrotropin-Releasing Hormone/adverse effects , Tomography, Emission-Computed, Single-PhotonABSTRACT
OBJECTIVE: To describe the brain CT and MR imaging findings of unusual acute encephalitis involving the thalamus. MATERIALS AND METHODS: We retrospectively reviewed the medical records and CT and/or MR imaging findings of six patients with acute encephalitis involving the thalamus. CT (n=6) and MR imaging (n=6) were performed during the acute and/or convalescent stage of the illness. RESULTS: Brain CT showed brain swelling (n=2), low attenuation of both thalami (n=1) or normal findings (n=3). Initial MR imaging indicated that in all patients the thalamus was involved either bilaterally (n=5) or unilaterally (n=1). Lesions were also present in the midbrain (n=5), medial temporal lobe (n=4), pons (n=3), both hippocampi (n=3) the insular cortex (n=2), medulla (n=2), lateral temporal lobe cortex (n=1), both cingulate gyri (n=1), both basal ganglia (n=1), and the left hemispheric cortex (n=1). CONCLUSION: These CT or MR imaging findings of acute encephalitis of unknown etiology were similar to a combination of those of Japanese encephalitis and herpes simplex encephalitis. In order to document the specific causative agents which lead to the appearance of these imaging features, further investigation is required.
Subject(s)
Encephalitis/diagnostic imaging , Encephalitis/pathology , Magnetic Resonance Imaging , Thalamus/diagnostic imaging , Thalamus/pathology , Tomography, X-Ray Computed , Acute Disease , Adult , Encephalitis/cerebrospinal fluid , Female , Humans , Male , Retrospective StudiesABSTRACT
American trypanosomiasis (Chagas' disease), a zoonosis caused by Trypanosoma cruzi with a high incidence in Latin America, may induce an uncommon form of localized encephalitis termed "chagoma", found in few immunocompromised patients. The computed tomography (CT) and magnetic resonance imaging (MRI) findings of brain chagoma are reported for 3 males (ages 32, 32 and 9 yr), the first 2 infected with human immunodeficiency virus (HIV) and the third with acute lymphoblastic leukemia. Diagnosis was confirmed by biopsy. CT disclosed a single, supratentorial, nodular-shaped lesion that substantially enhanced with contrast material, localized in parietal or frontal lobes. T1-weighted MRI showed hypointense lesions that enhanced with gadolinium-diethylenetriaminepentaacetic acid, corresponding to extensive hyperintense areas on T2-weighted images, producing mass effect. The imaging pattern of brain chagoma presented here is similar to that of cerebral toxoplasmosis and should be considered in the differential diagnosis of an intracerebral mass lesion in immunocompromised patients.
Subject(s)
AIDS-Related Opportunistic Infections/parasitology , Chagas Disease/diagnosis , Encephalitis/parasitology , Immunocompromised Host , Magnetic Resonance Imaging , Precursor Cell Lymphoblastic Leukemia-Lymphoma , Tomography, X-Ray Computed , AIDS-Related Opportunistic Infections/diagnosis , AIDS-Related Opportunistic Infections/diagnostic imaging , Adult , Chagas Disease/diagnostic imaging , Child , Contrast Media , Diagnosis, Differential , Encephalitis/diagnosis , Encephalitis/diagnostic imaging , Frontal Lobe/diagnostic imaging , Frontal Lobe/parasitology , Gadolinium , Gadolinium DTPA , Granuloma , Humans , Image Enhancement , Male , Organometallic Compounds , Parietal Lobe/diagnostic imaging , Parietal Lobe/parasitology , Pentetic Acid/analogs & derivatives , Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications , Radiographic Image Enhancement , Toxoplasmosis, Cerebral/diagnosisSubject(s)
Brain Abscess/diagnostic imaging , Encephalitis/diagnostic imaging , Adolescent , Adult , Aged , Brain Abscess/etiology , Brain Edema/diagnostic imaging , Child , Contrast Media , Diatrizoate , Diatrizoate Meglumine , Drug Combinations , Encephalitis/etiology , Female , Frontal Lobe/diagnostic imaging , Headache/etiology , Humans , Male , Middle Aged , Parietal Lobe/diagnostic imaging , Radiographic Image Enhancement , Sinusitis/complications , Temporal Lobe/diagnostic imaging , Tomography, X-Ray Computed , Vomiting/etiologyABSTRACT
PURPOSE: To describe the causes of infantile lenticulostriate vasculopathy (LSV) as demonstrated by sonography and propose the pathogenesis of these findings. METHODS: Five hundred eighty-six infants were examined via echoencephalography because of seizures, psychomotor retardation, dysmorphism, congenital malformation, microcephaly, macrocephaly, bulging of anterior fontanel, consciousness disturbance, or prematurity. We directed our attention on the sonographic study to the basal ganglionic and thalamic areas. Twenty-eight of the 586 patients underwent color Doppler studies. RESULTS: In 34 infants with gray-scale neurosonographic findings of LSV, 16 were associated with various causes that have been reported before. In 8 patients entities not previously associated with LSV were found: neonatal lupus, neonatal hypoglycemia, uncomplicated prematurity, encephalitis, and head injury. In the remaining 10 cases, a specific cause could not be found. The LSV was found in 16 (40%), 5 (14%), and 13 (3%) patients with perinatal, acquired, and nonspecific causes, respectively. Generally, this is an uncommon finding because it was observed in only 34 (5.8%) of the study infants; 24 of these 34 had a documented cause of the vasculopathy. With LSV associated with perinatal causes there was a greater chance of sonographic LSV's developing than with that of acquired causes. CONCLUSIONS: We suggest that sonographic LSV is a nonspecific marker of a previous insult to the developing brain, and the special hemodynamics of the fetal brain plays an important role in its pathogenesis.
Subject(s)
Cerebrovascular Disorders/diagnostic imaging , Corpus Striatum/blood supply , Corpus Striatum/diagnostic imaging , Echoencephalography , Basal Ganglia/diagnostic imaging , Birth Injuries/diagnostic imaging , Brain/abnormalities , Brain Diseases/diagnostic imaging , Cerebrovascular Disorders/congenital , Consciousness Disorders/diagnostic imaging , Encephalitis/diagnostic imaging , Facial Bones/abnormalities , Head Injuries, Closed/diagnostic imaging , Humans , Hypoglycemia/diagnostic imaging , Infant , Infant, Newborn , Infant, Premature , Lupus Erythematosus, Systemic/diagnostic imaging , Microcephaly/diagnostic imaging , Psychomotor Disorders/diagnostic imaging , Retrospective Studies , Seizures/diagnostic imaging , Skull/abnormalities , Thalamus/diagnostic imaging , Ultrasonography, Doppler, ColorABSTRACT
This report concerns a 68-year-old male who was diagnosed as having purulent ventriculitis based on CT and MRI findings. He was first admitted to a nearby hospital with fever and impaired consciousness and thought to be suffering from herpes simplex encephalitis based on laboratory findings. In spite of treatment with acyclovir and antibiotics, his symptoms persisted for one and a half months. Because of gradual deterioration of his neurological status, he was transferred to our hospital. On admission he was stuporous with nuchal rigidity and a fever of 38.5 degrees C. The CSF leukocyte count was elevated (217/mm3) with predominantly polymorphonuclear cells (mononuclear 20, polymorphonuclear 197). Gd-DTPA MRI (T1-weighted) showed marked enhancement of the ependyma of the fourth ventricle and both lateral ventricles. A diagnosis of purulent ventriculitis was made and high-dose antibiotics (ABPC 12g, CTX 9g) were started intravenously. Gradual improvement in the clinical signs was observed with rapid normalization of the CSF cell-count. The patient had completely recovered one month after the start of treatment and this was associated with disappearance of abnormal enhancement on the MRI images. Although cerebral ventriculitis occasionally occurs as a complication of neonatal meningitis, it is rare in adult purulent meningitis. In our patient, persistent meningitis combined with impaired drainage of CSF from the ventricles are presumed to have caused ventriculitis. Serial enhanced MRI is particularly helpful in diagnosing ventriculitis, and can serve as a good index for monitoring the effects of treatment.
Subject(s)
Cerebral Ventricles , Encephalitis/diagnosis , Aged , Contrast Media , Encephalitis/diagnostic imaging , Encephalitis/microbiology , Gadolinium DTPA , Herpes Simplex , Humans , Magnetic Resonance Imaging , Male , Organometallic Compounds , Pentetic Acid/analogs & derivatives , Tomography, X-Ray ComputedABSTRACT
Single photon emission computed tomography (SPECT) and cranial computed tomography were sequentially examined in 2 patients with acute encephalitis. Radiographic computed tomography revealed focal low-density areas within a few days of the onset of symptoms in both patients. In SPECT, 1 patient exhibited hyperperfusion in the corresponding area, while the other had a normal scan. The outcome of the former was poor, while the latter recovered fully. Abnormal brain perfusion, thus, coincided with a poor prognosis. SPECT may be used to promptly evaluate the focal change of acute encephalitis.
Subject(s)
Cerebrovascular Circulation/physiology , Encephalitis/diagnostic imaging , Herpes Simplex/diagnostic imaging , Tomography, Emission-Computed, Single-Photon/methods , Acute Disease , Child, Preschool , Encephalitis/physiopathology , Female , Herpes Simplex/physiopathology , Humans , Infant , Male , Regional Blood Flow/physiology , Temporal Lobe/blood supply , Thalamus/blood supplyABSTRACT
Symmetrical low density areas in the thalami at CT were found in an 11-month-old boy with measles encephalitis. The focal lesions on CT appeared to be localized inflammation, necrosis or edema. The cause of these lesions is unknown.
Subject(s)
Encephalitis/diagnostic imaging , Measles/complications , Thalamus/diagnostic imaging , Encephalitis/etiology , Humans , Infant , Male , Tomography, X-Ray ComputedABSTRACT
Unique CT findings were obtained in four cases of acute toxic encephalopathy, including two cases of clinical Reye's syndrome in the acute stage. Common findings in these cases were symmetrical low density in the thalami and the cerebellum (mainly the dentate nuclei) and similar changes in the surroundings of the lateral ventricles.